Keeping active and healthy is even more important at the time of menopause. Dr Lesley Hickin explains

It is essential to take a good look at your lifestyle in the run up to the menopause, not least because proper planning can help ease, if not alleviate, long-term problems like osteoporosis (brittle bones) and heart disease.

Bone strength in young adult life is boosted by a diet rich in foods containing calcium and vitamin D, together with regular weight-bearing exercise. Bones reach their peak mass in the 20s but after that your bone mass will depend on the body's response to hormones, along with hereditary factors and your lifestyle.

Smokers have a higher rate of bone-loss compared with non-smokers and might also have an earlier menopause. Among other things increasing your risks are a family history of osteoporosis, conditions with low oestrogen levels such as anorexia and exercise-induced amenorrhoea (the absence of periods for at least one year) and inadequate diet and exercise.

Exercise and diet is also thought to help relieve symptoms of the menopause. Using these can also help minimise other long-term affects that the reduction of hormones can bring, such as heart disease.

Preventing osteoporosis
Plenty of calcium in the diet is one way of reducing bone density loss. Foods rich in calcium include dairy products like milk, cheese and yoghurt, canned fish (with bones), bread, cereals and pulses, some green vegetables and several types of seeds and nuts (sesame seeds and peanuts, for example).

Levels of vitamin D, essential to help the body metabolise calcium, can be boosted by regular sun exposure. The best way to get your daily requirement is to try and sit out in the sun for between 10-15 minutes a day; if you do this in the summer months it will last you through to the end of the year. Vitamin D is also found naturally in oily fish, meat and meat products.

Other dietary considerations
If you have always struggled with your weight you will have to be even more diligent after the menopause. For various complicated and ill-understood reasons, women tend to gain weight after the menopause whether or not they take hormone replacement therapy. Fat is also redistributed, and the bulges you fought with before will have moved to the stomach, midriff and buttocks, and your breasts will lose their glandular elements to be replaced with fat, or they may shrivel up.

Try to reduce the amount of fat in your diet, and take regular exercise.

After the menopause you may think you don't need as much iron as you did when you were having regular periods, but it is still important to include iron-rich foods in your diet. These are red meat, poultry and fish. Vegetable sources of iron - such as pulses, nuts, dark green vegetables and dried fruits - are worth eating with foods rich in vitamin C (fresh citrus juices, salad or green vegetables) to improve the poor absorption of iron from these. Protection against heart disease and cancer are related to high dietary intake of anti-oxidant vitamins A, C and E.

Exercise
Aim for at least three sessions a week of aerobic exercise, each lasting 20-30 minutes. Aerobic exercise can be anything that makes you slightly breathless, but not so breathless that it prevents you from having a conversation. If you have health problems you might want to discuss the type of activity you plan to take up with a doctor before you start.

Ideal types of exercise include fast walking, gardening or swimming. Only weight-bearing exercises will reduce your risk of osteoporosis and these include dancing, skipping, walking, weightlifting, soccer, basketball and volleyball.

New solutions?
Phyto-oestrogens are a diverse group of chemical compounds not related to steroids. They are frequently recommended as an alternative to taking HRT during the menopause, but there is a lack of reliable evidence as to their efficacy. It cannot be said that they are ineffective, but more research needs to be done. The most evidence to date is about soy products, which contain phyto-oestrogens. They seem to reduce hot flushes without affecting any of the other symptoms from oestrogen lack. Good results have been found in trials using soy, but more work is necessary to evaluate long-term risks of taking large doses. There seem to be no risks attached to taking dietary amounts of soy products, but if you take large doses the oestrogenic effects can be a problem. They should be avoided in pregnancy and breast-feeding and can have some adverse effects such as breast tenderness and weight gain.